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Ann Thorac Surg 2009;88:1882-1888. doi:10.1016/j.athoracsur.2009.07.027
© 2009 The Society of Thoracic Surgeons
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Mani A. Daneshmand
Keki R. Balsara
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Original Articles: Adult Cardiac

"Hybrid" Repair of Aneurysms of the Transverse Aortic Arch: Midterm Results

G. Chad Hughes, MD*,*, Mani A. Daneshmand, MD, Keki R. Balsara, MD, Hardean A. Achneck, MD, Bantayehu Sileshi, MD, Sean M. Lee, MD, Richard L. McCann, MD

Department of Surgery, Duke University Medical Center, Durham, North Carolina

Accepted for publication July 10, 2009.

* Address correspondence to Dr Hughes, Duke University Medical Center, Box 3051, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Durham, NC 27710 (Email: gchad.hughes{at}duke.edu).

Presented at the Fifty-fifth Annual Meeting of the Southern Thoracic Surgical Association, Austin, TX, Nov 5–8, 2008.

Background: Aneurysms of the transverse aortic arch, especially those involving the mid to distal arch, are technically challenging to repair with conventional open techniques. We present our results with a combined open/endovascular approach ("hybrid repair") in such patients.

Methods: From August 11, 2005, to September 18, 2008, 28 patients underwent hybrid arch repair. For patients (n = 9) with distal arch aneurysms but 2 cm or more of proximal landing zone (PLZ) distal to the innominate artery, right to left carotid-carotid bypass was performed to create a PLZ by covering the left carotid origin. For patients (n = 12) with mid arch aneurysms but 2 cm or more of PLZ in the ascending aorta, proximal ascending aorta-based arch debranching was performed. For patients (n = 7) with arch aneurysms with no adequate PLZ ("mega aorta") but adequate distal landing zone, a stage 1 elephant trunk procedure was performed to create a PLZ. For the first two groups, endovascular aneurysm exclusion and debranching were performed concomitantly, whereas the procedures were staged for the group undergoing an initial elephant trunk procedure.

Results: Mean patient age was 64 ± 13 years. Primary technical success rate was 100%. Thirty-day/in-hospital rates of death, stroke, and permanent paraplegia/paresis were 0%, 0%, and 3.6% (n = 1), respectively. At a mean follow-up of 14 ± 11 months, there have been no late aortic-related events. Two patients (7%) required secondary endovascular reintervention for a type 1 endovascular leak. No patient has a type 1 or 3 endovascular leak at latest follow-up.

Conclusions: Hybrid repair of transverse aortic arch aneurysms appears safe and effective at midterm follow-up and may represent a technical advance in the treatment of this pathology.






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